3.1 Aortic Dissection Flashcards
Sharp Intense Chest pain and Tachycardia
DDx
Cardaic
- Aortic Dissection
- MI
- Myocarditis
- Pericarditis
- AR
Respiratory
- PE
- Pneumonia
- Spont PTX
- Pleurisy
MSK
- Acute mechanic back pain
- Costochondritis
GI
- Oes spasm
- Oes rupture
- Severe reflux
- Acute pancreatitis
- Obstructed / incarcerated epigastric hernia
Outline imagine modalities if Dissection suspected
CXR
TOE
CT
MRI
Aortography
CXR
Aortic knuckle
- may be obvious separation calcified intima
- Widened mediastinum
- Cardiomegaly
- Blunting costophrenic angle 2* haemothorax
TTE
Rapid and portable
Visualization of intimal flap in some cases
Provides dynamic information
-cardiac function
-aid assessment of patient
presence and severity of AR
Windows may be inadequate to exclude diagnosis Especially trauma obesity COPD severe calcified arterial disease
Results Operator dependent
CT
Cross sectional imaging
Contrast enhancement allow diagnosis confirmed
3D recon
better surgical planning for repair
Provides info about extent of flap
none about presence + severity AR
Relative quick / Non invasive
caution HD unstable
MRI
Excellent imaging quality
Slow acquire images
Unsuitable - unstable
Avoids contrast
Can assess presence AR
Requires specialist monitor / equipment magnet
C/I PM / Clips
Aortography
Historically gold standard
good viz dissection flap
false lumen
origin branch arteries
Invasive
Contrast
Slow
Management prior to transfer to CT centre
Initial
ABC structures approach
IV access fluid resus
Invasive monitoring
A line b-b BP
Serial ABG measure
Central access
infusion vasoactive
Bloods
FBC / U+E / Clotting
G+S / Troponin
Management prior to transfer
Collateral detailed medical history
ID suitability + Desire surgery
significant comorb
Fluid resus
SBP adequate for organ perfusion
avoid over-resus
Endpoint SBP 100-110
Analgesia
Urinary Catheter + hourly bag
Mx prior to transfer
BP
BP control
B block
First line - HR / Force contraction
Reduce shear force around origin dissection flap
- avoid tachycardia
Vasodilators
GTN / SNP short acting bp control
Ca++ channel antagonists
second line
